Commission nears deadline to redesign Medicaid

Reports sought for program's future in managed care system

Gov. Robert Bentley created the the Medicaid Advisory Commission to recommend how to redesign Alabama's $6.3 billion Medicaid program in a way that continues to provide services, but doesn't break the bank.

Dusty Compton | The Tuscaloosa News

By Dana BeyerleMontgomery Bureau Chief

Published: Thursday, December 13, 2012 at 3:30 a.m.

Last Modified: Wednesday, December 12, 2012 at 11:07 p.m.

MONTGOMERY | The Medicaid Advisory Commission is getting close to its deadline to recommend how to redesign Alabama's $6.3 billion Medicaid program in a way that continues to provide services, but doesn't break the bank.

The commission voted Wednesday to ask private and nonprofit managed care providers to submit preliminary reports by Jan. 8 showing how they view Medicaid's future in a managed care system.

That would give the commission just enough time to meet and consider recommendations to Gov. Robert Bentley by Jan. 31. Bentley's plan is to recommend changes to the Legislature, which begins its 2013 regular session in February.

Bentley tasked the commission he created with recommending ways to modernize Medicaid, which takes one-third of the discretionary general government budget or about $644 million this year. Without change, Medicaid may need an additional $100 million from the General Fund next year.

Medicaid is a state-federal program for qualifying low-income, disabled, and elderly residents. The program receives $4.5 billion in federal and local money and $1.8 billion in state and local funds.

The commission is studying options for the current Medicaid system to save taxpayers money while continuing to provide adequate service.

Medicaid's medical director said that the agency can expand a medical management system now in 21 counties to all 67 counties within six months.

Dr. Robert Moon said Medicaid delivers medical services in the Huntsville, Mobile, Opelika and West Alabama areas and can expand to all 67 counties.

“We can do it for that many,” Moon said.

Sylvia Brown, is the executive director of MedNet West Inc., one of four members of Patient Care Networks of Alabama that serves seven West Alabama counties. She said she believes the community-based care network can be expanded to serve the state.

“Our program is physicians-led, we connect with the community and we work very close with health department and federally qualified patients, and pharmacists for patients,” Brown said.

Alabama is one of three Southern states that does not use a form of managed care, a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.

Dr. Donald Williamson, the state health officer and the advisory commission's chairman, said it's almost inevitable that Medicaid will have to move to managed care in 2014.

“You have to decide whether to put the entire state in private managed care or community-based,” Williamson said. “A third way may be some hybrid of the two or something similar. Those are choices you have to make.”

States were given the option to expand Medicaid under new federal guidelines, but Bentley has said the state cannot afford to expand because of the eventual cost to state taxpayers.

Williamson previously warned of the expense of adding between 200,000 and 400,000 new Medicaid recipients to the Medicaid roll that now has at least 940,000 enrollees.

<p>MONTGOMERY | The Medicaid Advisory Commission is getting close to its deadline to recommend how to redesign Alabama's $6.3 billion Medicaid program in a way that continues to provide services, but doesn't break the bank.</p><p>The commission voted Wednesday to ask private and nonprofit managed care providers to submit preliminary reports by Jan. 8 showing how they view Medicaid's future in a managed care system.</p><p>That would give the commission just enough time to meet and consider recommendations to Gov. Robert Bentley by Jan. 31. Bentley's plan is to recommend changes to the Legislature, which begins its 2013 regular session in February.</p><p>Bentley tasked the commission he created with recommending ways to modernize Medicaid, which takes one-third of the discretionary general government budget or about $644 million this year. Without change, Medicaid may need an additional $100 million from the General Fund next year.</p><p>Medicaid is a state-federal program for qualifying low-income, disabled, and elderly residents. The program receives $4.5 billion in federal and local money and $1.8 billion in state and local funds.</p><p>The commission is studying options for the current Medicaid system to save taxpayers money while continuing to provide adequate service. </p><p>Medicaid's medical director said that the agency can expand a medical management system now in 21 counties to all 67 counties within six months.</p><p>Dr. Robert Moon said Medicaid delivers medical services in the Huntsville, Mobile, Opelika and West Alabama areas and can expand to all 67 counties.</p><p>“We can do it for that many,” Moon said.</p><p>Sylvia Brown, is the executive director of MedNet West Inc., one of four members of Patient Care Networks of Alabama that serves seven West Alabama counties. She said she believes the community-based care network can be expanded to serve the state.</p><p>“Our program is physicians-led, we connect with the community and we work very close with health department and federally qualified patients, and pharmacists for patients,” Brown said.</p><p>Alabama is one of three Southern states that does not use a form of managed care, a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.</p><p>Dr. Donald Williamson, the state health officer and the advisory commission's chairman, said it's almost inevitable that Medicaid will have to move to managed care in 2014.</p><p>“You have to decide whether to put the entire state in private managed care or community-based,” Williamson said. “A third way may be some hybrid of the two or something similar. Those are choices you have to make.”</p><p>States were given the option to expand Medicaid under new federal guidelines, but Bentley has said the state cannot afford to expand because of the eventual cost to state taxpayers.</p><p>Williamson previously warned of the expense of adding between 200,000 and 400,000 new Medicaid recipients to the Medicaid roll that now has at least 940,000 enrollees.</p>